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72

ACQ

Volume 12, Number 2 2010

ACQ

uiring knowledge in speech, language and hearing

already demanding schedules. If the situation is not

discussed and monitored closely, some parents may end up

feeling guilty and discouraged about the treatment process,

or worse, conceal the reality of their circumstances. Rather

than focusing on what the parent has not achieved, the SP

should attempt to build on what the parent has already

accomplished. For example, if a parent reports being able to

complete treatment for only 5 minutes per day, the SP may

suggest that an additional 2 minutes of treatment be applied

each week, until the recommended dose of treatment is

achieved. It is equally important to give parents the

opportunity to suggest their own solutions to any scheduling

problems. In doing so, parents may be more inclined to take

ownership of their ideas and follow through with the

solutions discussed. By setting parents up for success in this

way, the completion of treatment tasks should become a

more feasible part of their daily routine.

Problem 7

The child’s siblings distract the parent or child

during treatment.

Possible solution

When one child receives parental

attention to the exclusion of siblings, as may occur during

stuttering treatment, it is almost inevitable that siblings will

attempt to disrupt the session. If not resolved, the situation

could result in an overall reduction of treatment quality or

duration. One potential solution to the problem is to allow all

children to participate in treatment. In doing so, the parent

can focus treatment on the child for whom it is intended

while also attending to the demands of other siblings.

Another solution may be to prepare, in advance, an alternate

activity for siblings to complete while stuttering treatment is

being delivered. For this to succeed, the activity must be

appealing enough to keep the siblings interest for the entire

treatment session. A reward system may need to be

developed to ensure that the alternative activity is sufficiently

engaging and motivating. In fact, if a reward system has

already been developed for the child receiving stuttering

treatment, it may be advantageous to apply a similar reward

system to the alternative activity so as to minimise sibling

dispute.

demonstrate great insight into the fluctuations of their child’s

stuttering each day and require only minimal training in the

task of collecting scores. Nevertheless, when initially

instructing parents to use a severity rating scale it is

important to calibrate readings between users, or risk the

scale becoming potentially meaningless. To do so, a sample

of the child’s speech within the clinic can be rated

independently by both the clinician and parent. Severity

scores can then be compared and discussed until they differ

by no more than 1-scale point. During the calibration stage,

it is important for clinicians to emphasise that the severity

scale does not require parents to count the actual number or

type of stutters present. Rather, scores should be a

subjective reflection of the child’s typical level of stuttering

each day. On the whole, provided that the clinician discusses

severity rating scores regularly, it is likely that parents will

continue collecting them consistently.

Problem 5

The parent has difficulty identifying stutters.

Possible solution

Given that many preschool children

exhibit normal disfluency as they acquire language, it can be

difficult for parents to identify stuttered moments during the

day. Accordingly, parents can be instructed to consider only

unambiguous stuttering when attempting to assess severity

in this age group. Unambiguous stuttering refers to speech

behaviours that can be clearly and unequivocally categorised

as either repeated movements or fixed postures (see

Teesson, Packman, & Onslow, 2003). When uncertain, the

general rule should be to overlook ambiguous disfluencies.

Some parents, however, may need assistance in

distinguishing stuttering from normal disfluency. To do so, a

sample of the child’s speech within the clinic can be

assessed by the clinician, reporting back to the parent when

stuttering has occurred. With modelling and clear instruction,

it is likely that parents will learn to identify stuttering quickly

and accurately.

Problem 6

Parents are unable to schedule regular

treatment times.

Possible solution

It is common for parents to feel

overwhelmed with the addition of treatment tasks to their

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